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The introduction of Intracytoplasmic Sperm Injection (ICSI) over the past five years has revolutionised the management of male infertility.

Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg; this procedure is most commonly used to overcome male infertility problems.

The procedure is done under a microscope using micromanipulation devices (micromanipulators, microinjectors and micropipettes). A holding pipette (on picture on left) stablizes the mature oocyte. from the opposite site a thin, hollow needle is pierced into the inner part of the oocyte, the oolemma. it is loaded with a single sperm that will be released into the oocyte. The pictured oocyte has an extruded polar body at about 12 o'clock indicating its maturity. After the procedure, the oocyte will be placed into cell culture and checked on the following day for signs of fertilization.

In natural fertilisation sperm compete and when the first sperm enters the egg cell, the egg cell blocks the entry of any other sperm. Concern has been raised that in ICSI this sperm selection process is bypassed and the sperm is selected by the embryologist without undergoing any specific testing. However, in mid 2006 the FDA cleared a device that allows embryologists to select mature sperm for ICSI based on sperm binding to hyaluronan, the main constituent of the gel layer (cumulus oophorus) surrounding the oocyte. The device provides microscopic droplets of hyaluronan hydrogel attached to the culture dish. The embryologist places the prepared sperm on the microdot, selects and captures sperm that bind to the dot. Basic research on the maturation of sperm shows that hyaluronan-binding sperm are more mature and show fewer DNA strand breaks and significantly lower levels of aneuploidy than the sperm population from which they were selected.

There is some suggestion that birth defects are increased with the use of IVF in general, and ICSI specifically. It is hoped that use of new device (PICSI) will lower the apparently elevated level of birth defects associated with ICSI.

There are various medical conditions that can cause infertility which include:

Diabetes

Pituitary gland disease

Hypothalamus disorder

Multiple sclerosis

Chlamydia

Prostatitis

Cushing’s syndrome

Hypogonadism

Mumps

There are two types of diabetes – Type 1 and Type 2 which are both to do with abnormally high levels in sugar in the bloodstream. Type 1 starts in childhood and is where the body is unable to produce any insulin.

Type 2 affects mainly older people and is where the body is unable to produce enough insulin. It is also known as ‘insulin-dependant’ diabetes.

How does this relate to infertility? A body of research has shown that there is a link between diabetes and male infertility. It appears to be the case that sperm produced by a man with diabetes are more damaged than those from a non-diabetic.

These damaged sperm are unable to fertilise an egg which leads to problems with conceiving.

Further studies are needed in order to determine the extent of the problem but it does seem to suggest that this will be a major cause of male infertility in the future.

Pituitary gland disease is classed as a hormonal problem and one of the many causes of male infertility. If it fails to send the correct signals to activate the testes then testosterone levels will drop which affects sperm production.

The hypothalamus is responsible for testosterone production but problems with this can reduce testosterone levels which directly impacts upon fertility levels.

Multiple sclerosis is a condition which affects myelin – the protective coating on nerve fibres which enable messages to be transmitted from the brain to the rest of the body. This myelin becomes damaged which then affects these messages.

In respect of male fertility, the layer of myelin on the nerves which control sexual response become damaged which disrupts this response, leading to problems with erection and ejaculation.

Chlamydia is a sexually transmitted disease (STD) which has come to our attention in recent years. It is most prevalent in young people and is a major area of concern for experts as it can have long term effects. And one of these effects is infertility.

It affects the quantity, shape and movement of sperm which damages male fertility.

Prostatitis is inflammation of the prostate gland which can cause permanent infertility if left untreated. Symptoms of this include painful ejaculation and urination.

Cushing’s syndrome is a hormonal disorder which is caused by excessive levels of cortisol in the body. Cortisol is produced by the adrenal glands and is responsible for a variety of functions which include: regulating blood pressure and the immune system, controlling blood sugar levels and an appropriate response to stress (‘fight or flight’).

But too much cortisol causes a whole range of problems which include:

Muscle weakness

Obesity

Water retention (around the ankles)

Reduced libido (and reduced fertility)

High blood pressure

Aches and pains

Excess thirst

Mood swings

Reduced libido (or lack of a sex drive) is likely to affect your sexual performance and ability to conceive.

Hypogonadism is a condition which can occur as a result of an injury or disease to the pituitary glands, hypothalamus or testicles. It can decrease the levels of the hormone gonadotrophin which in turn, lowers testosterone levels.

Mumps is a common childhood illness which usually causes no long term effects but, complications do happen. It is especially problematic for adult men as it can infect the testicles, causing orchitis which may cause sterility.

Around 20 to 30% cases of men with mumps experience orchitis. Symptoms of this include tenderness, swelling and a fever and it tends to occur a week after the outbreak of the disease.

Other general medical conditions which cause infertility include kidney disease, cancer, high blood pressure, stroke and coronary heart disease.

Ejaculation problems include a failure to ejaculate, sperm retention or a flushing of sperm into the bladder instead (known as retrograde ejaculation).

Problems with ejaculation can be caused by the following:

Disease such as multiple sclerosis or diabetes

Paralysis (spinal cord injury)

Damage occurred during surgery

Psychological issues

Certain medications such as high blood pressure medication

Other ejaculation problems include premature ejaculation and delayed ejaculation. Premature ejaculation is the condition in which the man ejaculates too quickly during sexual intercourse. This is much more common than delayed ejaculation in which ejaculation doesn’t happen straight away even though you have a normal erection.